Foundations Exam 3 Flashcards
Influenza strain type associated with pandemics?
Influenza type A
(Type A subtypes:
Hemagglutinins H1, H2, H3
Neuraminidases N1, N2)
Incubation period, transmission, and infectious period - Influenza
incubation 2-3 days
transmission is via respiratory droplets/direct contact
pt infectious usually a day before sxs start and will last up to a week
Name general sxs of Flu
Fever Aches (myalgias) Chills ( cough - non-productive) Tiredness Sudden onset
HA, ocular sxs, sore throat
How is Influenza virus testing performed?
Testing options?
Nasopharyngeal swabs
- RAT - rapid antigen test, results in <15 mins, not a perfect test
- Culture, result in 3-10 days
- RT-PCR - more accurate, but $$, test time 1-8 hrs
High risk groups that Flu Rx treatment is indicated for..
Extremes of ages Chronic illnesses (cardiac, pulm, renal, DM) Immunosuppression Pregnancy/post partum (2wks) Children <19yo on chronic ASA therapy Native Americans Morbidly obese (BMI>40) Residents in nursing homes
WHEN should Influenza treatment be initiated?
First 24-48hrs
Rx may take ~1-3 days off course and severity of sxs
Antiviral Flu medication options
Neuraminidase Inhibitors:
- Oseltamivir (Tamiflu) most common
- Zanamivir (Relenza)
- Peramivir (Rapivab) IV med only
ADEs of Oseltamivir (Tamiflu)
n/v 10% most common side effect
in peds, possible agitation, hallucinations, SI (should discuss w parents)
ADEs of Zanamivir (Relenza)
Bronchospasm - shouldn’t give to asthmatic pts or those w airway compromise
Complications of Influenza
PNA** Sinusitis Otitis Media Myositis/Rhabdomyolysis CNS involvement Cardiac complications
Flu prevention- who gets vaccinated?
everyone >6 months of age
annually ~Oct becomes available
Peds pt (6 months - 8yrs) first season of Flu vaccination- schedule ?
2 doses, > 4 weeks apart
1st dose primes their immune system- 2nd dose at or after 4 wk mark, okay for it to be different vaccine
Flu vaccine considerations for adults 65+
-higher dose vaccine
(believed elderly have harder time mounting immune response so high dose given)
-adjuvanted seasonal vaccine for adults 65+
Acute bronchitis clinical presentation
Cough >5 days (~1-3 weeks) \+/- productive Usually afebrile chest wall tenderness Wheezing Mild dyspnea
Acute bronchitis etiology
VIRAL - most common
(even if pt presents with purulent sputum - could just be viral)
Bacterial - pathogens: mycoplasma, c pneumoniae, bordetella pertussis* (only one that should be given Abx tx)
Acute bronchitis PE findings
Wheezing
Rhonchi (clears with coughing)
Negative for rales and signs of consolidation
Incubation and contagious time for Pertussis
Incubation 7-17 days
Contagious for 2 wks after onset of mild cough (during catarrhal stage)
Stages of Pertussis
Catarrhal 1-2 wks
(malaise, rhinorrhea, mild cough, milder fever)
Paroxysmal lasts 2-3 months
(paroxysmal cough - whooping cough, +/- post-tussive syncope or emesis)
Covalescent 1-2 wks
(gradual reduction in freq and severity of cough)
1st line Tx for Pertussis
Macrolides
*Azithromycin 500mg day 1, 250mg day 2-5
Clarithromycin 500mg BID x 7 days
Erythromycin 500mg QID x 7 days
TMP-SMX 160-800mg BID x 7 days
When should pregnant women receive Tdap?
b/w 27-36 weeks gestation, or immediately postpartum
all infants - Dtap
11-18yo Tdap booster
All adults single Tdap dose
Pregnant women - with each pregnancy
How is PNA transmitted?
- Aspiration from oropharynx
- Inhalation of contaminated droplets
- Hematogenous (blood) spread
- Extension from infected pleural or mediastinal space
(don’t catch PNA from someone- might get their URI - but generally PNA occurs b/c of aspiration of organisms)
PNA- pathogen and classic presentation
S pneumoniae
sudden onset of chills
rust colored sputum
most common of CAP 2/3 cases
PNA- pathogen and classic presentation
M pneumoniae
- historically children and adolescents
- may be asymptomatic or mild
- CXR - reticulonodular pattern/patchy areas of consolidation
- Bullae on TM
PNA- pathogen and classic presentation
Legionella
GI disorders (watery diarrhea) Confusion or encephalopathy outbreaks usu from contaminated water sources
PNA- pathogen and classic presentation
MRSA
- cavitary infiltrate or necrosis
- gross hemoptysis
- rapidly increasing pleural effusions
PNA- pathogen and classic presentation
Klebsiella pneumoniae
- comorbidities usu ETOH abuse, DM, severe COPD
- “currant jelly” sputum (thick, mucoid, blood tinged)
What are the atypical PNA pathogens?
Mycoplasma pneumoniae
Chlamydophilia pneumoniae
Legionella
C psittaci
atypical a historical term, does not mean uncommon - means unresponsive to beta lactams
PNA severity index vs
CURB-65
index scores to assess whether pt should be treated inpatient or outpatient
PSI - pts > 50yo, w pre-existing conditions and PE abnormalities then stratified on add’l risk factors
CURB 65 - shorter list, pts >65yo
Confusion Urea >7 or BUN >20 (modified version omits) RR >30breath/mins BP (SBP <90, DBP <60) 65 - age +
Score 1-2 consider hosp
Score 3-4 urgent hosp +/- ICU
CAP Tx outpatient
Macrolide or Doxycycline
if risk factors for macrolide resistance or Abx last 3 months
Respiratory fluoroquinolone
or
Beta lactam (high dose Amoxicillin or Augmentin) PLUS macrolide
duration Abx at least 5 days
CAP inpatient (non-ICU) Tx
Respiratory fluoroquinolone
or
Beta lactam PLUS macrolide
CAP ICU inpatient Tx
anti-pneumococcal beta-lactam PLUS azithromycin
or
anti-pneumococcal beta-lactam PLUS
a respiratory fluoroquinolone
If PCN allergic: respiratory fluoroquinolone PLUS aztreonam
CAP ICU for pseudomonas risk Tx
Antipneumococcal, antipseudomonal beta lactam (Cefipime) PLUS either ciprofloxacin or levofloxacin
or
above beta lactam PLUS aminoglycoside PLUS azithromycin (or respiratory fluoroquinolone)
FULL duration 14 day treatment (14-21 days)**
CAP ICI Tx for MRSA
If MRSA risk:
Add vancomycin or linezolid
Duration of Tx for HAP, VAP PNA
duration of Tx 14-21 days
if pt responds to initial tx may limit to 7 days
**if Pseudomonas aeruginosa needs to be full duration 14 days minimum
Top 3 most common causes of ARDS?
#1 Diffuse PNA #2 Sepsis #3 Aspiration
What is the Berlin definition?
All 4 criteria must be met to Dx ARSD
- acute onset w/in 1 wk of known clinical insult
- bilateral pulmonary infiltrates
- respiratory failure not explained by HF or volume overload
- mod-severe O2 impairment (ABGs <300mmHg)
Spontaneous pneumothorax, clinical presentation, 1st line diagnostics, and treatment ?
Usu tall, thin, young men 20-40yo, smokers
Dyspnea, pleuritic CP unilateral and sharp
1st line CXR (best in lateral decubitus view) and CT chest, U/S if emergent at bedside
Tx 100% O2
Small pneumothorax - observe
Large - needle aspiration
Unstable- chest tube
Describe a tension pneumothorax
medical emergency, 1-2% of primary spontaneous pneumothorax
pt looks really sick! distended neck veins, hypotension, tracheal deviation, worsening dyspnea
CXR mediastinal shift and tracheal deviation contralateral side, flattening or inversion diaphragm ispsilateral side
pt needs chest tube
Cause and treatment of secondary spontaneous pneumothorax?
occurs as complication of underlying lung dz
more severe than PSP
pts should be hospitalized, most will req chest tube
P-HTN
Group 1, etiology
Pulmonary arterial hypertension (PAH)
secondary to various disorders..
idiopathic portal HTN Drugs/toxins (appetite suppressants, SSRIs) HIV Schistosomiasis CT d/o congenital heart dz
P-HTN
Group 2, etiology
Pulmonary venous hypertension secondary to left heart disease
P-HTN
Group 3 etiology
1 COPD
secondary to lung disease or hypoxemia
ILD
OSA
high altitudes
